Outcome of intracerebral hemorrhage associated with different oral anticoagulants

Wilson, Duncan and Seiffge, David J. and Traenka, Christopher and Basir, Ghazala and Purrucker, Jan C. and Rizos, Timolaos and Sobowale, Oluwaseun A. and Sallinen, Hanne and Yeh, Shin-Joe and Wu, Teddy Y. and Ferrigno, Marc and Houben, Rik and Schreuder, Floris H.B.M. and Perry, Luke A. and Tanaka, Jun and Boulanger, Marion and Al-Shahi Salman, Rustam and Jäger, Hans Rolf and Ambler, Gareth and Shakeshaft, Clare and Yakushiji, Yusuke and Choi, Philip M.C. and Staals, Julie and Cordonnier, Charlotte and Jeng, Jiann-Shing and Veltkamp, Roland and Dowlatshahi, Dar and Engelter, Stefan T. and Parry-Jones, Adrian R. and Meretoja, Atte and Werring, David J. and Emsley, Hedley (2017) Outcome of intracerebral hemorrhage associated with different oral anticoagulants. Neurology, 88 (18). pp. 1693-1700. ISSN 0028-3878

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Objective: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non–vitamin K antagonist oral anticoagulation–related ICH (NOAC-ICH) and vitamin K antagonist–associated ICH (VKA-ICH). Methods: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery. We addressed heterogeneity using a shared frailty term. Good functional outcome was defined as discharge modified Rankin Scale score ≤2 and investigated in multivariable logistic regression. ICH volume was measured by ABC/2 or a semiautomated planimetric method. HE was defined as an ICH volume increase >33% or >6 mL from baseline within 72 hours. Results: We included 500 patients (97 NOAC-ICH and 403 VKA-ICH). Median baseline ICH volume was 14.4 mL (interquartile range [IQR] 3.6–38.4) for NOAC-ICH vs 10.6 mL (IQR 4.0–27.9) for VKA-ICH (p = 0.78). We did not find any difference between NOAC-ICH and VKA-ICH for all-cause mortality within 90 days (33% for NOAC-ICH vs 31% for VKA-ICH [p = 0.64]; adjusted Cox hazard ratio (for NOAC-ICH vs VKA-ICH) 0.93 [95% confidence interval (CI) 0.52–1.64] [p = 0.79]), the rate of HE (NOAC-ICH n = 29/48 [40%] vs VKA-ICH n = 93/140 [34%] [p = 0.45]), or functional outcome at hospital discharge (NOAC-ICH vs VKA-ICH odds ratio 0.47; 95% CI 0.18–1.19 [p = 0.11]). Conclusions: In our international collaborative multicenter pooled analysis, baseline ICH volume, hematoma expansion, 90-day mortality, and functional outcome were similar following NOAC-ICH and VKA-ICH.

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12 Apr 2017 08:36
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23 Sep 2020 03:27